Document Text Contents
Page 2
THE EVERYDAY GEOGRAPHIES OF LIVING WITH DIABETES
i
ABSTRACT
Diabetes is a condition often placed on the margins of ‘seriousness’. It is often
believed to impact minimally on an individual’s everyday life and, while this may be
true for some people, living with diabetes is not always experienced so ‘easily’.
Research from myriad disciplines has begun to shed light on the complex personal
issues of living with the condition, but, with a few exceptions, there is little input from
human geography. This thesis hence explores the ‘geographies of diabetes’ in more
detail. The findings hinge around a ‘recession’ of the diabetic body in public space.
This recession is both discursive and material, caused by the assumptions and
expectations of others that diabetes is among the minor of chronic conditions, largely
overcome by insulin and ever advancing technologies which enable greater self-
control over the diabetic body. Visible diabetic bodies are hence subject to a
disciplining gaze, for having transgressed these expectations.
This thesis finds that, despite many people displaying their diabetes minimally
in public, the condition impacts greatly on a personal level. People with diabetes are
aware that their bodies are at risk of both short- and long-term complications more so
than if they did not have diabetes. These vulnerabilities serve to create anxious bodies
for whom everyday spontaneity is curbed and dependency is heightened. In order to
conceal the visible signifier of diabetes, to avoid the disciplining gaze, people
‘perform’ aspects of their self-management, hence further obscuring the anxious
realities of living with diabetes. The embodied differences of having diabetes along
with the discursive ‘recession’ of the condition, contribute to an ideal of ‘diabetic
citizenship’. It is to this ‘diabetic citizen’ – who experiences the condition with few
problems, and with any difficulty attributed to personal and moral failing – that many
people with diabetes express their frustration. Through the methods of online
questionnaires and face-to-face interviews, this thesis raises awareness of the
clandestine geography experienced by people with diabetes.
Page 160
CHAPTER 6 THE SPATIAL CONTINGENCIES OF LIVING WITH DIABETES
152
CHAPTER 6
THE SPATIAL CONTINGENCIES OF LIVING WITH DIABETES
“Why the pluck would you want to be injecting insulin 99% of the places you
mention? … All you do is eat a couple of sweets to solve the problem [of
hypoglycaemia]. What has safe got to do with it?” (Elliot).
INTRODUCTION
In Chapter 2 I introduced the wealth of literature concerned with the effectiveness of
DAFNE courses in improving life with diabetes. I argued that, while this research has
merit, its usefulness for understanding the day-to-day life of PWD is limited. It flirts
only briefly with spatial issues, often confining the evaluations of the DAFNE course
to immediate eating practices. Living everyday with diabetes is so much more, and I
argued that an increased sensitivity to space and place is vital when attempting to
understand the lifeworld of a PWD. Such investigations have been commenced by
Mol (2008), and I wish to expand further on her observations. In this chapter I will
discuss the spatial contingencies of life with diabetes. Taking certain spaces in turn, I
will make reference to parts of my questionnaire which asked participants to rate how
‘safe’ they would feel if they were to experience a hypo in a list of various public and
private spaces. These results will be presented in chart form to show trends. I will also
draw upon interview responses, allowing them to complicate the basic questionnaire
results. Of course, my directing of questions in both the questionnaire and interviews
to broad spaces such as home, work and public spaces meant that I often controlled
the direction of this spatial discussion. However, contradictions between the
questionnaire rating scale questions and written or oral responses from participants
demonstrate how these discussions were much more intriguing than simple
assumptions; of, for example, private and home spaces = safe / public spaces = unsafe.
Participants co-opted the questions to express their own distinctive spatial frustrations
and spatial strategies, and their responses are imbued with ideas about concealment
and exposure of diabetes in certain spaces. This finding raises questions about how
the treatment and care of PWD should be approached by clinicians, with perhaps more
focus on diabetes as a spatially diverse condition rather than one that is bounded only
within the ideal practices and aims taught in hospital spaces. While the Scottish
Page 317
REFERENCE LIST
309
van Amsterdam, Noortje. Big fat inequalities, thin privilege: An intersectional
perspective on ‘body size’ pp. 155-169 in European Journal of Women’s Studies,
Volume 20, Number 2, 2013
Vaz, Paulo; Bruno, Fernanda. Types of Self-Surveillance: from abnormality to
individuals ‘at risk’ pp. 272-291 in Surveillance and Society, Volume 1, Number 3,
2003
Weiner, Diane. Ethno genetics: Interpreting Ideas about Diabetes and Inheritance pp.
155-184 in American Indian Culture and Research Journal, Volume 23, Number 3,
1999
Wendell, Susan. Unhealthy disabled: Treating chronic illnesses as disabilities pp.
161-176 in The Disability Studies Reader eds. David, Lennard J, Routledge, New
York, 2013
Westman, Eric C; Yancy JR, William, S; Humphreys, Margaret. Dietary Treatment
of Diabetes Mellitus in the Pre-Insulin Era (1914-1922) pp. 77-83 in Perspectives in
Biology and Medicine, Volume 49, Number 1, 2006
Wije, Asha. “Case report – disability discrimination” no page numbers in Human
Resource Management International, Volume 20, Number 2, 2012
Wiles, Janine L; Rosenberg, Mark W; Kearns, Robin A. Narrative analysis as a
strategy for understanding interview talk in geographic research pp. 89-99 in Area,
Volume 37, Number 1, 2005
Wilkin, T. J. The accelerator hypothesis: weight gain as the missing link between type
1 and Type 2 diabetes pp. 914-922 in Diabetologia, Volume 44, 2001
Wilkin, T. J. The accelerator hypothesis cannot be tested using the type 2 diabetes
gene, TCF7L2 p. 1780 in Diabetologia, Volume 50, 2007
Williams, Clare. Gender, adolescence and the management of diabetes pp. 1160-1166
in Journal of Advanced Nursing, Volume 30, Number 5, 1999
Williams, Clare. Doing health, doing gender: teenagers, diabetes and asthma pp. 387-
396 in Social Science & Medicine, Volume 50, 2000
Wilson, Matthew W. Cyborg geographies: towards hybrid epistemologies pp. 499-
516 in Gender, Place and Culture, Volume 16, Number 5, 2009
Wilton, Robert D. Diminished worlds? The geography of everyday life with
HIV/AIDS pp. 69-83 in Health & Place, Volume 2, Number 2, 1996
Wilton, Robert D. Qualitative Health Research: Negotiating Life with HIV/AIDS pp.
254-264 in Professional Geographer, Volume 51, Number 2, 1999
THE EVERYDAY GEOGRAPHIES OF LIVING WITH DIABETES
i
ABSTRACT
Diabetes is a condition often placed on the margins of ‘seriousness’. It is often
believed to impact minimally on an individual’s everyday life and, while this may be
true for some people, living with diabetes is not always experienced so ‘easily’.
Research from myriad disciplines has begun to shed light on the complex personal
issues of living with the condition, but, with a few exceptions, there is little input from
human geography. This thesis hence explores the ‘geographies of diabetes’ in more
detail. The findings hinge around a ‘recession’ of the diabetic body in public space.
This recession is both discursive and material, caused by the assumptions and
expectations of others that diabetes is among the minor of chronic conditions, largely
overcome by insulin and ever advancing technologies which enable greater self-
control over the diabetic body. Visible diabetic bodies are hence subject to a
disciplining gaze, for having transgressed these expectations.
This thesis finds that, despite many people displaying their diabetes minimally
in public, the condition impacts greatly on a personal level. People with diabetes are
aware that their bodies are at risk of both short- and long-term complications more so
than if they did not have diabetes. These vulnerabilities serve to create anxious bodies
for whom everyday spontaneity is curbed and dependency is heightened. In order to
conceal the visible signifier of diabetes, to avoid the disciplining gaze, people
‘perform’ aspects of their self-management, hence further obscuring the anxious
realities of living with diabetes. The embodied differences of having diabetes along
with the discursive ‘recession’ of the condition, contribute to an ideal of ‘diabetic
citizenship’. It is to this ‘diabetic citizen’ – who experiences the condition with few
problems, and with any difficulty attributed to personal and moral failing – that many
people with diabetes express their frustration. Through the methods of online
questionnaires and face-to-face interviews, this thesis raises awareness of the
clandestine geography experienced by people with diabetes.
Page 160
CHAPTER 6 THE SPATIAL CONTINGENCIES OF LIVING WITH DIABETES
152
CHAPTER 6
THE SPATIAL CONTINGENCIES OF LIVING WITH DIABETES
“Why the pluck would you want to be injecting insulin 99% of the places you
mention? … All you do is eat a couple of sweets to solve the problem [of
hypoglycaemia]. What has safe got to do with it?” (Elliot).
INTRODUCTION
In Chapter 2 I introduced the wealth of literature concerned with the effectiveness of
DAFNE courses in improving life with diabetes. I argued that, while this research has
merit, its usefulness for understanding the day-to-day life of PWD is limited. It flirts
only briefly with spatial issues, often confining the evaluations of the DAFNE course
to immediate eating practices. Living everyday with diabetes is so much more, and I
argued that an increased sensitivity to space and place is vital when attempting to
understand the lifeworld of a PWD. Such investigations have been commenced by
Mol (2008), and I wish to expand further on her observations. In this chapter I will
discuss the spatial contingencies of life with diabetes. Taking certain spaces in turn, I
will make reference to parts of my questionnaire which asked participants to rate how
‘safe’ they would feel if they were to experience a hypo in a list of various public and
private spaces. These results will be presented in chart form to show trends. I will also
draw upon interview responses, allowing them to complicate the basic questionnaire
results. Of course, my directing of questions in both the questionnaire and interviews
to broad spaces such as home, work and public spaces meant that I often controlled
the direction of this spatial discussion. However, contradictions between the
questionnaire rating scale questions and written or oral responses from participants
demonstrate how these discussions were much more intriguing than simple
assumptions; of, for example, private and home spaces = safe / public spaces = unsafe.
Participants co-opted the questions to express their own distinctive spatial frustrations
and spatial strategies, and their responses are imbued with ideas about concealment
and exposure of diabetes in certain spaces. This finding raises questions about how
the treatment and care of PWD should be approached by clinicians, with perhaps more
focus on diabetes as a spatially diverse condition rather than one that is bounded only
within the ideal practices and aims taught in hospital spaces. While the Scottish
Page 317
REFERENCE LIST
309
van Amsterdam, Noortje. Big fat inequalities, thin privilege: An intersectional
perspective on ‘body size’ pp. 155-169 in European Journal of Women’s Studies,
Volume 20, Number 2, 2013
Vaz, Paulo; Bruno, Fernanda. Types of Self-Surveillance: from abnormality to
individuals ‘at risk’ pp. 272-291 in Surveillance and Society, Volume 1, Number 3,
2003
Weiner, Diane. Ethno genetics: Interpreting Ideas about Diabetes and Inheritance pp.
155-184 in American Indian Culture and Research Journal, Volume 23, Number 3,
1999
Wendell, Susan. Unhealthy disabled: Treating chronic illnesses as disabilities pp.
161-176 in The Disability Studies Reader eds. David, Lennard J, Routledge, New
York, 2013
Westman, Eric C; Yancy JR, William, S; Humphreys, Margaret. Dietary Treatment
of Diabetes Mellitus in the Pre-Insulin Era (1914-1922) pp. 77-83 in Perspectives in
Biology and Medicine, Volume 49, Number 1, 2006
Wije, Asha. “Case report – disability discrimination” no page numbers in Human
Resource Management International, Volume 20, Number 2, 2012
Wiles, Janine L; Rosenberg, Mark W; Kearns, Robin A. Narrative analysis as a
strategy for understanding interview talk in geographic research pp. 89-99 in Area,
Volume 37, Number 1, 2005
Wilkin, T. J. The accelerator hypothesis: weight gain as the missing link between type
1 and Type 2 diabetes pp. 914-922 in Diabetologia, Volume 44, 2001
Wilkin, T. J. The accelerator hypothesis cannot be tested using the type 2 diabetes
gene, TCF7L2 p. 1780 in Diabetologia, Volume 50, 2007
Williams, Clare. Gender, adolescence and the management of diabetes pp. 1160-1166
in Journal of Advanced Nursing, Volume 30, Number 5, 1999
Williams, Clare. Doing health, doing gender: teenagers, diabetes and asthma pp. 387-
396 in Social Science & Medicine, Volume 50, 2000
Wilson, Matthew W. Cyborg geographies: towards hybrid epistemologies pp. 499-
516 in Gender, Place and Culture, Volume 16, Number 5, 2009
Wilton, Robert D. Diminished worlds? The geography of everyday life with
HIV/AIDS pp. 69-83 in Health & Place, Volume 2, Number 2, 1996
Wilton, Robert D. Qualitative Health Research: Negotiating Life with HIV/AIDS pp.
254-264 in Professional Geographer, Volume 51, Number 2, 1999
